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Objective:To evaluate the predictive value of the serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration for postoperative acute kidney injury (AKI) in neonates undergoing cardiac surgery.Methods:Perioperative data of 110 consecutive neonates (≤28 days) who underwent cardiac surgery in our hospital from October 2017 to May 2021, were collected retrospectively.According to pROCK criteria, the patients were divided into AKI group and non-AKI group.Demographics, predominant diagnosis, laboratory examination, perioperative management and postoperative outcomes were compared between two groups.The concentration of serum NT-proBNP was routinely measured within 12 h after operation.Multivariate logistic regression analysis was performed for the association between serum NT-proBNP and postoperative AKI.Receiver operating characteristic curve was drawn, and the predictive value of serum NT-proBNP for postoperative AKI was determined according to the area under the curve.Results:A total of 106 neonates were enrolled, and the incidence of postoperative AKI was 54.7%.There were significant difference in the baseline hemoglobin concentration, hematocrit and serum creatinine and serum NT-proBNP concentration between AKI group and non-AKI group ( P<0.05). Multivariate logistic regression analysis indicated that NT-proBNP level was an independent risk factor for AKI after cardiac surgery in neonates ( odds ratio 2.49, 95% confidence interval 1.183-5.23, P=0.016). The area under the curve of NT-proBNP predicting AKI after cardiac surgery was 0.66 (95% confidence interval 0.56-0.76, P=0.007). Conclusions:Elevated serum NT-proBNP concentration is an independent risk factor for AKI after cardiac surgery in neonates and has a certain predictive value for AKI, and close monitoring of perioperative NT-proBNP level is helpful for early identification of high-risk neonates.
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Objective To investigate the risk factors of severe hemolysis during extracorporeal membrane oxygenation (ECMO). Methods The clinical data of adult patients undergoing ECMO after cardiac surgery admitted to Fuwai Hospital from December 2010 to October 2015 were retrospectively analyzed. Demographic characteristics, renal function, primary disease, operation data, ECMO related data and outcomes were recorded. Patients were divided into normal free hemoglobin (FHB) group (FHB ≤ 500 mg/L) and severe hemolysis group (FHB > 500 mg/L) according to the FHB level during ECMO support. The parameters before and after ECMO support were compared between the two groups. Logistic regression was used to identify the independent risk factors of severe hemolysis. Results A total of 81 patients including 19 patients with severe hemolysis was enrolled, and 62 in normal FHB group. There was no difference in cardiopulmonary bypass (CPB) time, clamping time, lactate level before ECMO, cardiopulmonary resuscitation, intra-aortic balloon pump use and central catheter insertion between two groups. The maximums of serum creatinine (SCr) and FHB levels were higher in severe hemolysis group as compared with those in normal FHB group [maximal SCr (μmol/L): 281.02±164.11 vs. 196.67±87.31, maximal FHB (mg/L): 600 (600, 700) vs. 200 (100, 300)], the incidence of clots in circuit or oxygenator, infection, and hemofiltration in severe hemolysis group was increased [26.3% (5/19) vs. 4.8% (3/62), 31.6% (6/19) vs. 12.9% (8/62), 36.8% (7/19) vs. 14.5% (9/62), all P < 0.1]. As well as outcomes including the rate of site of surgery or intubation bleeding and acute renal failure [ARF, 57.9 % (11/19) vs. 30.6% (19/62), 94.7% (18/19) vs. 41.9% (26/62)], and the survival rate was lowered [10.5% (2/19) vs. 51.6% (32/62), all P < 0.05]. As result of univariate analysis, clots in circuit or oxygenator, infection and hemofiltration were associated with severe hemolysis. It was showed by logistic regression analysis that the clots in circuit or oxygenator was a risk factor of severe hemolysis during ECMO [odds ratio (OR) = 6.262, 95% confidence interval (95%CI) = 1.244-31.515, P = 0.026]. Conclusions The clots in circuit or oxygenator were independent risk factors of severe hemolysis during ECMO. Severe hemolysis can induce the increase of the rate of bleeding in the operation site or intubation and the rate of ARF, and decrease of the survival rate.
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OBJECTIVE: To retrospectively review the clinical data of patients receiving extracorporeal membrane oxygenation (ECMO) during the last 10 years in Fuwai Hospital in order to assess the factors associated with the outcome of patients who had undergone ECMO, as well as to summarize the clinical experience, and to adopt a treatment strategy for future clinical decision. METHODS: The clinical data of adult patients undergoing ECMO admitted to Fuwai Hospital from December 2004 to December 2014 were retrospectively analyzed. Demographic characteristics, diagnosis, ECMO related data, including ECMO indication, operation, undergoing cardiopulmonary resuscitation (CPR) or not, and site of establishment, clinical parameters before and 24 hours after ECMO, duration of ECMO, and complications were collected to set up a database. The patients were divided into survival group and non-survival group according to the prognosis. The risk factors of mortality in hospital after ECMO were analyzed by logistic regression. RESULTS There were 142 adult patients who had received ECMO support, with 106 male and 36 female. All patients received veno-arterial ECMO (V-A ECMO). The indication of ECMO in 59 patients was unsuccessful weaning from extracorporeal circulation (41.5%), and that of 44 patients was low cardiac output cardiogenic shock (31.0%). CPR was necessary in 34 out of 142 patients undergoing ECMO. In 37 patients intra-aortic balloon pump (IABP) was necessary. ECMO was successfully weaned in 99 patients (69.7%), and 84 patients (59.2%) survived. The most frequent complication during ECMO support was bleeding from site of catheterization or operation (45.8%). Logistic regression revealed that high lactic acid levels [odds ratio (OR) = 1.469, 95% confidence interval (95%CI) = 1.170-1.843, P = 0.001] and high blood glucose (OR = 0.984, 95%CI = 0.969-0.999, P = 0.037) at 24 hours after ECMO, multiple organ dysfunction syndrome (MODS, OR = 17.243, 95%CI = 3.177-93.581, P = 0.001), gastrointestinal bleeding (OR = 8.774, 95%CI = 1.414-54.457, P = 0.020) were risk factors of in-hospital mortality in adult patients undergoing ECMO. CONCLUSIONS: ECMO can provide effective auxiliary support in patients with respiratory and circulatory failure, which 'shows good clinical effect. Strict indication, timely ECMO support and sophisticated management are the keys to the success of ECMO. The most frequent complications during ECMO support is bleeding from site of catheterization or operation. High lactic acid levels at 24 hours after ECMO, MODS and gastrointestinal bleeding are predictors of in-hospital mortality in adult patients, and appropriate control of blood sugar was beneficial for the recovery of patients.
